California Licensed Incident Management Specialist

Job Summary

To support grievance and appeal resolutions, the full-time California Licensed Incident Management Specialist will coordinate investigations, communicate with members and advocates, and ensure compliance with regulations while working remotely.

Key responsibilities:

• Manage the resolution of grievances and appeals by investigating cases and preparing documentation for medical committees
• Collaborate with cross-functional teams to address member issues related to healthcare delivery and benefits
• Document and maintain confidentiality of case information while ensuring compliance with internal and external regulations

Required qualifications:

• Minimum one (1) year of experience in customer service or a related field
• Bachelor's degree in Business Administration, Health Care Administration, or a related field, along with two (2) years of relevant experience, or five (5) years of experience in health care or health insurance
• Knowledge of health care compliance and incident management processes
• Strong interpersonal skills and ability to manage diverse relationships
• Experience in data entry and maintaining accurate records